Understanding seasonal patterns of acute malnutrition and common childhood diseases in Afghanistan

Evidence from 14 and five years of admission data on acute malnutrition and diseases, respectively

2025-06-23

Background

  • Seasonality/seasonal variation refers to recurring patterns at specific times of the year.  
  • It has impact on the underlying and immediate factors that drives acute malnutrition (AMN).  
  • It is known that AMN has a seasonal variation, however limited evidence is available to substantiate that.
    • Stakeholders often rely on assumptions of an AMN seasonal peak during the food security lean season.
      • Nutrition surveys are routinely timed to coincide with the lean season each year.

Objective

  • Understand the seasonal patterns of acute malnutrition and the most common childhood diseases, in order to provide evidence-based inputs for IPC AMN analysis parameters and to inform the timing of nutrition data collection in Afghanistan

Methods

Source of data

  • Fourteen years of admission data on acute malnutrition into the country’s treatment programme
    • Data was provided:
      • Broken down by severe acute malnutrition (SAM) and moderate acute malnutrition cases
        • These were aggregated to form the Global Acute Malnutriton (GAM)
    • Broken down by provinces (all of them)
  • Five years of admission data on child diseases

Analysis

  • Exploratory (visual) data analysis: to inspect possible underneath patterns

    • If:
      • patterns were similar across provinces:
        • aggregate data as National
    • Otherwise:
      • Analyse the provinces with distinct patterns as one

  • Time series decomposition: a process of extracting the underlying trend and seasonal variation from the time series

  • Current seasonal variation was determined on the basis of the patterns exihibited over the last three years

Results

  • Acute Malnutrition

A glance at the evolution of admissions over time (1/2)

A glance at the evolution of admissions over time (2/2)

Key messages

  • The level of admissions rose as of September 2021, like never seen before. It reached its highest point in December 2021 with over 150K cases. Thereafter, it remained high over time, like never seen before as well.

Question?

What may have hapenned in the 3rd quarter of 2021 and thereafter?

The components

Seasonal patters - National

Evolution of the seasonal pattern over time

Before 2015

Between 2016 and 2019

Between 2020 and 2022

As of 2022

Seasonal patters in Farah and Nimrus Provinces (1/2)

Evolution of the seasonal pattern over time in Farah and Nimrus Provinces

Before 2015

Between 2016 and 2017

Between 2018 and 2019

Between 2020 and 2021

As of 2021

Translating graphs into seasonal calendars 🗓️

AMN seasonal calendar

gantt
    title  AMN seasonal calendar based on the pattens as of 2022
    dateFormat M
    axisFormat %b
    todayMarker off

    section National
    Nadir :1, 6
    Peak : 6, 7
    Nadir: 7, 8
    High peak :8, 10
    Nadir :10, 12

    section Farah and Nimruz
    Nadir :1, 6
    Peak : 6, 7
    Nadir: 7, 9
    High peak :9, 11
    Nadir :11, 12
  • Key message
    • 2 High AMN seasons
      • In Farah and Nimruz Provinces, the high-peak exhibits a slight shift compared to the national
    • 1 Long low AMN season

Results

  • Common childhood diseases

A glance at the evolution of admissions over time

The components

Seasonal patters - National

Translating graphs into seasonal calendars 🗓️

Child morbidity seasonal calendar


gantt
    title  Child morbidity seasonal calendar
    dateFormat M
    axisFormat %b
    todayMarker off

    section Acute Respiratory Infections
    Stable (high) :1, 3
    Decrease : 3, 7
    Increase: 7, 12

    section Pneumonia
    Stable (high) :1, 3
    Decrease : 3, 7
    Increase: 7, 12

    section AWD
    Decrease : 1, 3
    Increase : 3, 8
    Decrease : 8, 12

    section Malaria
    Decrease : 1, 4
    Increase : 4, 9
    Decrease : 9, 12

    section Measles
    Decrease : 1, 2
    Increase : 2, 4
    Decrease : 4, 12

AMN, child morbidities and AFI seasonal calendars

gantt
    title  AMN, child morbidity and AFI seasonal calendar
    dateFormat M
    axisFormat %b
    todayMarker off

    section National AMN
    Nadir :1, 6
    Peak : 6, 7
    Nadir: 7, 8
    High peak :8, 10
    Nadir :10, 12

    section Farah and Nimruz's AMN
    Nadir :1, 6
    Peak : 6, 7
    Nadir: 7, 9
    High peak :9, 11
    Nadir :11, 12

    section Acute Respiratory Infections
    Stable (high) :1, 3
    Decrease : 3, 7
    Increase: 7, 12

    section Pneumonia
    Stable (high) :1, 3
    Decrease : 3, 7
    Increase: 7, 12

    section AWD
    Decrease : 1, 3
    Increase : 3, 8
    Decrease : 8, 12

    section Malaria
    Decrease : 1, 4
    Increase : 4, 9
    Decrease : 9, 12

    section Measles
    Decrease : 1, 2
    Increase : 2, 4
    Decrease : 4, 12

    section Acute Food Insecurity
    Lean : 1, 4
    Harvest : 4, 7
    Post-harvest : 7, 11
    Lean: 11, 12